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Cheil Mineral 5 weeks (10mL/10V)

Cheil Mineral 5 weeks (10mL/10V)


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Precautions for use

1. Warnings
 1) Benzyl alcohol has been reported to be associated with fatal shortness of breath in premature infants. 
 2) Do not inject directly without dilution as there is a possibility of phlebitis.
 3) Since this drug is a low osmotic solution, use only for mixed injections.
 4) If toxicity occurs from any one component, stop administration immediately.
 5) Because parenteral nutrient solution contains aluminum, it may reach toxic levels through long-term parenteral administration when renal function declines. It is especially dangerous for premature infants with immature kidneys.

2. Do not administer to the following patients:
  Newborns, premature infants (contains benzyl alcohol) 

3. Adverse reactions
  The amount of zinc, copper, manganese, chromium, and selenium contained in this drug is very small, so toxic symptoms at the prescribed dose This doesn't happen well.

4. General Precautions
 1) Before injection, the doctor should determine the patient's morbidity and metabolic requirements. Five plasma trace elements should be monitored frequently for dose adjustment. 
 2) Zinc is excreted by the intestines and kidneys, so patients with renal failure may develop zinc retention.
 3) Copper and manganese are excreted in bile, so patients with biliary obstruction may develop retention.
 4) Manganese supplementary secretion pathway includes pancreatic juice, and reabsorption also occurs in the duodenum, jejunum, and ileum.
 5) Chromium is mainly excreted through the kidneys. In addition, since chromium affects the maintenance of normal glucose homeostasis, it is necessary to consider whether the patient is diabetic.
 6) Selenium is excreted in urine and feces, so the dosage of selenium should be adjusted in case of renal or gastrointestinal disorders. For transfusion patients, the effects of transfusion should be considered.
    Selenium enhanced the action of vitamin E and reduced the toxicity of mercury, cadmium and arsenic in animal studies.

5. Administration to Pregnant
 Women 1) When high doses of selenium (15-30㎍/egg) were administered to chickens, adverse developmental reactions were reported, but there were no adequate studies on pregnant women.
 2) There is a report that selenium was detected in the placenta and umbilical cord blood of pregnant women. 
 3) Since the safety of administration during pregnancy has not been established, if it is administered to a pregnant woman or a woman who may be pregnant, it should be administered only when it is judged that the therapeutic benefit outweighs the potential risk.

6. Treatment in case of overdose
 1) Intravenous administration of 1 to 2 mg of zinc per kg body weight to adult leukemia patients did not show any toxicity. However, when 10 mg was administered to an adult patient for 1 hour, the plasma zinc concentration was 207 μg/mL on the fourth day, and symptoms such as hyperhidrosis, loss of consciousness, blurred vision, tachycardia (140 times/min), and marked hypothermia (34.6°C) were observed. Acute toxicity symptoms were reported, but symptoms were relieved within 3 hours. Hyperamylaseemia may be a signal that zinc is imminent at high doses. Inadequate administration of an excessive amount of parenteral nutritional fluid (TPN) (25 mg/L zinc, 50 to 70 mg zinc per day) resulted in hyperamylaseemia (557 to 1,850 Klein units, normal value 130 to 310).
    A 72-year-old patient died when overdose of 1,683 mg of zinc for more than 60 hours. The symptoms of zinc toxicity were hypotension (80/40 mmHg), pulmonary edema, diarrhea, vomiting, jaundice, and decreased urine output. The plasma zinc concentration was 4,184㎍/100mL.
    Calcium supplementation is known to have a preventive effect on zinc toxicity. Normal plasma zinc concentration is about 88-112 μg/100 mL.
 2) Copper toxicity symptoms include collapse, behavioral change, diarrhea, progressive wasting, hypotension, glare and peripheral edema in the literature. These symptoms were reported when the plasma copper concentration was 286㎍/100mL. 
    D-penicillamine is effective as an antidote, and the normal plasma copper concentration is about 80-160 μg/100 mL. 
 3) The symptoms of manganese toxicity are unknown in patients receiving parenteral nutritional solutions at the prescribed dose. Manganese toxicity from excessive intake of manganese from food or beverages is also unknown.
 4) Chromium toxicity symptoms include nausea, vomiting, ulcers, gastrointestinal disorders, renal disorders, liver disorders, and abnormalities of the central nervous system leading to convulsions and coma. No toxicity was observed when trivalent chromium was administered at a dose of 250 μg per day for 2 weeks to patients receiving parenteral nutritional fluid. The acute LD50 of intravenous administration of trivalent chromium is 10-18 mg/kg.
 5) Selenium has been reported in the literature for chronic toxicity due to industrial environment, intake of food grown in selenium-containing soil, selenium-contaminated water supply, and use of selenium-containing cosmetics. Toxic symptoms include hair loss, nail weakness, dermatitis, tooth damage, gastrointestinal disorders, nervousness, depression, metallic taste, vomiting, and the smell of garlic when sweating and breathing. In case of acute toxicity due to excessive selenium intake, death occurs along with histopathological changes such as blunt peripheral vascular collapse, intravascular congestion, pulmonary hemorrhage, congestion, edema, and pigmentation of gastric mucosa (red brick color), leading to death and coma has appeared There is still no adequate antidote for selenium poisoning, and the normal plasma selenium concentration is about 10-37 μg/100 mL.

7. Precautions for application
 1) Do not use without a doctor's prescription.
 2) When adding this drug to parenteral nutrient solution, it is preferable to do it in laminar flow to maintain sterility.
 3) If it is possible to confirm through the solution and container, it should be checked for discoloration or particulates before administering the solution.
 4) The trace elements contained in this drug are physically safe to use together with the electrolytes and vitamins present in the amino acid/glucose solution used as parenteral nutritional fluid.

8. Precautions for storage
 1) Store this medicine in a packaged state at room temperature in a dry place.
 2) Keep out of reach of children.
 3) Putting it in another container may cause an accident or is not desirable in terms of quality maintenance.

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